HomeMy WebLinkAbout0135 Declaration of~ Dor~iicile and t;i?~~~~ship
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Yo0 THT GZ.ERR OF TAE CIRCUIT COURT.
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5~.. LUC i E
COUNTY. FLORIDA: t
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c `~'lbis is m~ deeLration d Domide and (~ti:enship k the State d Florida that I sm 8liat this dq in aoooedanoe. and Is F .
. _ eoniarmi~j with Section ~.1T. Florida Statutes. ` ~ -
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I was ~ s kgal re:ides~t d ~
1~' ~ tiQc~^+0~~ Q _ ~h1 p , and I
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resided at J 3 ~ ~ ' • Cfi - However. I have changed mT domio'la b
IStred aaa Nam>»rl
and sm and have a bona Sde resident d the State d Florida since ~ da,T d
19~~ and I reside at ~ ~ Q -
18tr..t asdNomb.el
~ ~ ~ ST. LUG 1 E Florida. _
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and this statement is to be taken as m7 declaration d eitisenship. actual legal residence and domia7e in the State d F7or+ds.
IF FOR THE PURPOSE OF~ENROLLING- IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL~-PLEASE STATE PLEASE-CHECKS
THEIR NAMESS
~y
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455956
19T9 A!!G 23 Ali ~ 16
• STL UCIE FEC Y 0
CLERK CiRCUR COURT
RECOAO VERIFIrQ
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I FtJRTSER 4'ERTTf'Y that I w~ register at mT Iocal address when the registration boob reopen. and wmplT with aD
other re9mremeats d a legal rewideat d this State.
I FURTIiEIt CERTg7C that I have no intention to return to mT former domia'Ie. a~ I intend to remain in
T. U C I E , Couat~.
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Florid,, permanenti,:
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crE eown • ILi ~
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~ndan..l ~ B i h i. n~ 4-n~
swop to and wbea,'hed betare me this daT d
R C K OF CIRCUIT COURT
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ST. 1 E COUNTY, fLaR 1 _ - .
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' EPUTY LERK
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